A prospective study of isolation and mortality in a cohort of elderly Navajo Indians
WNV Monitoring on the Navajo Nation
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Transcript of WNV Monitoring on the Navajo Nation
2014 Update of the odd Zoonotic Diseases on
Navajo
Dr. Scott Bender, DVMTribal Veterinarian
Navajo Nation Veterinary ProgramNavajo Nation Dept. of Agriculture
Navajo Nation
What you need to know…..
Last terrestrial case on Navajo 1949
Closest Endemic areas are in Eastern NM,
Southwestern AZ
Skunks –
New Mexico and Southern Arizona
Gray Fox – Central Arizona
Bats‐
9/26/13, Sawmill, AZ
Bat to Skunk & Fox. Flagstaff 2000…..
Management Protocol:
Wound care critical
Animal quarantine before any Rabies treatment
(Dog/Cat)
100% die within 10 days of signs IF POSITIVE
Rabies Antibody – Day 0
Human Vaccinations ‐
Day 0, Day 3, Day 7, Day 14
Unless bat bite – start immediately.
Plague
Don’t ever blame the p. dogs!
Continuing to move east and north
Entered via San Francisco from China.
Currently hot zone is NM
A genetic disease resistance…..700 years
old…..
Three Forms
Bubonic plague: enlarged, tender lymph nodes,
fever, chills and prostration
Septicemic plague: fever, chills, prostration,
abdominal pain, shock and bleeding into skin and other organs
Pneumonic plague: fever, chills, cough and difficulty
breathing; rapid shock and death if not treated early
Plague on Navajo
Ft. Defiance 2009, 2010, 2012
Window Rock 2008
Ganado 2003
Blood samples collected
Dog Titer 19,800 : 1
Treated with Oxytetracycline
Recovered fine.
P Dog Vaccine trial‐
slated for this year.
Ganado and NAPI areas, and 5 other US sites.
Fly Larva infections “Myiasis”
Can happen to any species
Humans usually secondary
Rodent / rabbit hunting
Occasional untreated wound infections
Some types used for septic wound debridement.
Two primary types: Blowfly & Botfly
Screw worm in S. America.
East VS West
Old World.
Generally kidney – hemorrhagic
First big outbreak‐
Korean War
New World
Respiratory HVPS
Largely unknown until the 1990
May have been historical Navajo “outbreaks”
–
oral reports that fit
syndrome.
Arena Virus are EXTENSIVE in N & S America
~22 types identified so
far, all rodent assoc.
Sanitation, sanitation, sanitation……
This infects humans by the fecal –
respiratory
route….
So how do we prevent this……..
SANITATION…..(Bleach it ‘til it GLOWS!!!)
Exclusion
Onchocerca
Parasitic worm family
Cervicalis
(horse, cattle), Cervipedis (deer, elk)
Oncocerca lupi
Mediterranean area‐
Greece, Turkey, Iran
Human case in Lukachukai
All affect Humans
Confused with and more common:
Visceral and Cutaneous Larval Migrans
(Toxocara canis and Ancylostoma spp.)
Human Symptoms
Takes 6‐12 months to develop
Microfilaria spread by large biting insects (horse
or deer flies)
Usually skin lesions.
Dx‐
Skin Biopsy
Dx: DNA or adult female morphology
Rx: Ivomec
Chaga’s Disease (Trypanosoma cruzi)
“Kissing”
or “Assassin”
Bug Heart Disease
Report of high titers in SW wildlife
Thunderstorm over Round Rock
Mule Bridge, Grand Canyon
Competent Vector?
Yes‐
in Central – South America
Unknown in North America
Navajo‐
Triatoma navajoii??
Rocky Mt Spotted Fever
Continues to be an issue on White Mountain, San
Carlos, Tohono O’odham, Salt River
Ticks moved on DOGS move RMSF
Known as “black measles”
Most deaths in children
“malaise and fever”
(commercial lab test
questionable) and petechial rash.
Navajo: Three FALSE positives so far this 2012‐
MUST have increase in titer over two weeks to be a
confirmed positive
Rx: tetracycline, Doxycycline
Background issues….
Brown Dog tick involved
Tick control important
Dogs on east Navajo have higher titers in survey 2006
CDC repeated Study 2012
SAME FINDINGS!!!!
$1,000,000 QUESTION!
Why do we have high background titers to RMSF in our
folks…..
A nature “VACCINATION”?????
5 OF 10 positive in Farmington area. (Q fever investigation)
Bartonella spp
“New Disease”???
“Cat scratch fever”
in this class.
30 new Bartonella species
One human case in NC of sheep associated
Endocarditis
Present in some Navajo sheep
Found in Sheep Keds….
(But not known to bite humans)
Still an unknown……
Q FEVERFirst Human positive in several years (2011)Generally sheep and goat associatedAbortions of small ruminantsOriginally slaughter house diseaseLikely local human casesSingle titer doesn’t “prove”
ANY PERSON POSITIVE MUST HAVE A 2nd
TITER TO BE CALLED POSITIVE
Goat outbreak in Farmington area‐10 people tested, all negative.
(5 positive for RMSF!!!)
“Watch for Animals; Next 140 miles” US160, Navajo Nation
“Tulie”‐ Tularemia
Rabbit skinners disease
Insect spread
Human‐
open wound or scratch
Eating undercooked rabbit or rodent
species.
Rez has “hot spots”
Last cases 2009 in White Cone area..
Road kill rabbit for dinner = 2 human cases
Triconella spiralis‐
8 species identified
Pig to human (undercooked pork)
Bears to Humans (undercooked meat)
Pig species killed by freezing
Bear (silvatic) species is NOT killed by
freezing
100% of dogs in Shiprock & Chinle infected.
Brucella canis
• First confirmed case on Navajo 4/2011• Second 2013• Both dogs from central Navajo • Zoonotic- ~ 60 human conf. cases• 4% background antibodies (human) • Fever, malaise, Heart • Significance??????
Leptospirosis‐ 5 serovars
Human bloody diarrhea
Kidney infections‐
urine contamination.
Dx: Silver stain on urine
Water associated
So around the San Juan???
Outbreak in Cottonwood, AZ in 2010
Southern New Mexico Cattle abortions 2013
Sero survey on Navajo 116 dogs….
NO
POSITIVES
(so may not be an issue???)